|
MESH PROLENE(6.1*13.7C)2.4*5.4
|
Facility
|
OP
|
$1,962.79
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.16 |
| Max. Negotiated Rate |
$1,884.28 |
| Rate for Payer: Aetna Commercial |
$1,511.35
|
| Rate for Payer: Anthem Medicaid |
$675.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.98
|
| Rate for Payer: Cash Price |
$981.40
|
| Rate for Payer: Cigna Commercial |
$1,629.12
|
| Rate for Payer: First Health Commercial |
$1,864.65
|
| Rate for Payer: Humana Commercial |
$1,668.37
|
| Rate for Payer: Humana KY Medicaid |
$675.00
|
| Rate for Payer: Kentucky WC Medicaid |
$681.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,472.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.46
|
| Rate for Payer: PHCS Commercial |
$1,884.28
|
| Rate for Payer: United Healthcare All Payer |
$1,727.26
|
|
|
MESH PROLENE (7.6X15CM) 3*6
|
Facility
|
OP
|
$1,770.62
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.18 |
| Max. Negotiated Rate |
$1,699.80 |
| Rate for Payer: Aetna Commercial |
$1,363.38
|
| Rate for Payer: Anthem Medicaid |
$608.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.08
|
| Rate for Payer: Cash Price |
$885.31
|
| Rate for Payer: Cigna Commercial |
$1,469.61
|
| Rate for Payer: First Health Commercial |
$1,682.09
|
| Rate for Payer: Humana Commercial |
$1,505.03
|
| Rate for Payer: Humana KY Medicaid |
$608.92
|
| Rate for Payer: Kentucky WC Medicaid |
$615.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.89
|
| Rate for Payer: PHCS Commercial |
$1,699.80
|
| Rate for Payer: United Healthcare All Payer |
$1,558.15
|
|
|
MESH PROLENE (7.6X15CM) 3*6
|
Facility
|
IP
|
$1,770.62
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.18 |
| Max. Negotiated Rate |
$1,699.80 |
| Rate for Payer: Aetna Commercial |
$1,363.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.08
|
| Rate for Payer: Cash Price |
$885.31
|
| Rate for Payer: Cigna Commercial |
$1,469.61
|
| Rate for Payer: First Health Commercial |
$1,682.09
|
| Rate for Payer: Humana Commercial |
$1,505.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.89
|
| Rate for Payer: PHCS Commercial |
$1,699.80
|
| Rate for Payer: United Healthcare All Payer |
$1,558.15
|
|
|
MESH PROLITE ULTRA 6*6
|
Facility
|
IP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
MESH PROLITE ULTRA 6*6
|
Facility
|
OP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem Medicaid |
$381.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Humana KY Medicaid |
$381.04
|
| Rate for Payer: Kentucky WC Medicaid |
$384.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
MESH REVIZE COLLAGEN 4CM*16CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESH REVIZE COLLAGEN 4CM*16CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESH STRATTICE CONTUR 9*18.5CM
|
Facility
|
OP
|
$13,264.50
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,724.38 |
| Max. Negotiated Rate |
$12,733.92 |
| Rate for Payer: Aetna Commercial |
$10,213.66
|
| Rate for Payer: Anthem Medicaid |
$4,561.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,346.31
|
| Rate for Payer: Cash Price |
$6,632.25
|
| Rate for Payer: Cigna Commercial |
$11,009.54
|
| Rate for Payer: First Health Commercial |
$12,601.28
|
| Rate for Payer: Humana Commercial |
$11,274.82
|
| Rate for Payer: Humana KY Medicaid |
$4,561.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,608.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,876.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,789.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,979.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,653.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,672.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,948.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,652.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,724.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,112.00
|
| Rate for Payer: PHCS Commercial |
$12,733.92
|
| Rate for Payer: United Healthcare All Payer |
$11,672.76
|
|
|
MESH STRATTICE CONTUR 9*18.5CM
|
Facility
|
IP
|
$13,264.50
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,724.38 |
| Max. Negotiated Rate |
$12,733.92 |
| Rate for Payer: Aetna Commercial |
$10,213.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,346.31
|
| Rate for Payer: Cash Price |
$6,632.25
|
| Rate for Payer: Cigna Commercial |
$11,009.54
|
| Rate for Payer: First Health Commercial |
$12,601.28
|
| Rate for Payer: Humana Commercial |
$11,274.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,876.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,789.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,979.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,672.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,948.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,652.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,724.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,112.00
|
| Rate for Payer: PHCS Commercial |
$12,733.92
|
| Rate for Payer: United Healthcare All Payer |
$11,672.76
|
|
|
MESH STRATTICE FIRM 20*30CM
|
Facility
|
IP
|
$81,134.80
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,547.52 |
| Max. Negotiated Rate |
$77,889.41 |
| Rate for Payer: Aetna Commercial |
$62,473.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,285.14
|
| Rate for Payer: Cash Price |
$40,567.40
|
| Rate for Payer: Cigna Commercial |
$67,341.88
|
| Rate for Payer: First Health Commercial |
$77,078.06
|
| Rate for Payer: Humana Commercial |
$68,964.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,530.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,877.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,340.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,398.62
|
| Rate for Payer: Ohio Health Group HMO |
$60,851.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,226.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,151.79
|
| Rate for Payer: PHCS Commercial |
$77,889.41
|
| Rate for Payer: United Healthcare All Payer |
$71,398.62
|
|
|
MESH STRATTICE FIRM 20*30CM
|
Facility
|
OP
|
$81,134.80
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,547.52 |
| Max. Negotiated Rate |
$77,889.41 |
| Rate for Payer: Aetna Commercial |
$62,473.80
|
| Rate for Payer: Anthem Medicaid |
$27,902.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,285.14
|
| Rate for Payer: Cash Price |
$40,567.40
|
| Rate for Payer: Cigna Commercial |
$67,341.88
|
| Rate for Payer: First Health Commercial |
$77,078.06
|
| Rate for Payer: Humana Commercial |
$68,964.58
|
| Rate for Payer: Humana KY Medicaid |
$27,902.26
|
| Rate for Payer: Kentucky WC Medicaid |
$28,186.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,530.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59,877.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,340.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,462.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,398.62
|
| Rate for Payer: Ohio Health Group HMO |
$60,851.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,226.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,151.79
|
| Rate for Payer: PHCS Commercial |
$77,889.41
|
| Rate for Payer: United Healthcare All Payer |
$71,398.62
|
|
|
MESH STRATTICE PREFORATD 20*25
|
Facility
|
IP
|
$73,816.00
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,596.08 |
| Max. Negotiated Rate |
$70,863.36 |
| Rate for Payer: Aetna Commercial |
$56,838.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,576.48
|
| Rate for Payer: Cash Price |
$36,908.00
|
| Rate for Payer: Cigna Commercial |
$61,267.28
|
| Rate for Payer: First Health Commercial |
$70,125.20
|
| Rate for Payer: Humana Commercial |
$62,743.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,529.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,476.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,144.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,958.08
|
| Rate for Payer: Ohio Health Group HMO |
$55,362.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,763.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,596.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,882.96
|
| Rate for Payer: PHCS Commercial |
$70,863.36
|
| Rate for Payer: United Healthcare All Payer |
$64,958.08
|
|
|
MESH STRATTICE PREFORATD 20*25
|
Facility
|
OP
|
$73,816.00
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,596.08 |
| Max. Negotiated Rate |
$70,863.36 |
| Rate for Payer: Aetna Commercial |
$56,838.32
|
| Rate for Payer: Anthem Medicaid |
$25,385.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,576.48
|
| Rate for Payer: Cash Price |
$36,908.00
|
| Rate for Payer: Cigna Commercial |
$61,267.28
|
| Rate for Payer: First Health Commercial |
$70,125.20
|
| Rate for Payer: Humana Commercial |
$62,743.60
|
| Rate for Payer: Humana KY Medicaid |
$25,385.32
|
| Rate for Payer: Kentucky WC Medicaid |
$25,643.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,529.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,476.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,144.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,894.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,958.08
|
| Rate for Payer: Ohio Health Group HMO |
$55,362.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,763.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,596.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,882.96
|
| Rate for Payer: PHCS Commercial |
$70,863.36
|
| Rate for Payer: United Healthcare All Payer |
$64,958.08
|
|
|
MESH SURGIMND MP 16CM*20CM*3MM
|
Facility
|
IP
|
$26,992.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.96 |
| Max. Negotiated Rate |
$25,912.32 |
| Rate for Payer: Aetna Commercial |
$20,783.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,053.76
|
| Rate for Payer: Cash Price |
$13,496.00
|
| Rate for Payer: Cigna Commercial |
$22,403.36
|
| Rate for Payer: First Health Commercial |
$25,642.40
|
| Rate for Payer: Humana Commercial |
$22,943.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,133.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,920.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,097.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,752.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,244.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,398.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,508.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,367.52
|
| Rate for Payer: PHCS Commercial |
$25,912.32
|
| Rate for Payer: United Healthcare All Payer |
$23,752.96
|
|
|
MESH SURGIMND MP 16CM*20CM*3MM
|
Facility
|
OP
|
$26,992.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.96 |
| Max. Negotiated Rate |
$25,912.32 |
| Rate for Payer: Aetna Commercial |
$20,783.84
|
| Rate for Payer: Anthem Medicaid |
$9,282.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,053.76
|
| Rate for Payer: Cash Price |
$13,496.00
|
| Rate for Payer: Cigna Commercial |
$22,403.36
|
| Rate for Payer: First Health Commercial |
$25,642.40
|
| Rate for Payer: Humana Commercial |
$22,943.20
|
| Rate for Payer: Humana KY Medicaid |
$9,282.55
|
| Rate for Payer: Kentucky WC Medicaid |
$9,377.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,133.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,920.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,097.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,468.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,752.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,244.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,398.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,508.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,367.52
|
| Rate for Payer: PHCS Commercial |
$25,912.32
|
| Rate for Payer: United Healthcare All Payer |
$23,752.96
|
|
|
MESH SURGIMND MP 20CM*10CM*1MM
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
MESH SURGIMND MP 20CM*10CM*1MM
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
MESH SURGIMND MP 20CM*20CM*2MM
|
Facility
|
IP
|
$34,000.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,420.00 |
| Max. Negotiated Rate |
$32,640.00 |
| Rate for Payer: Aetna Commercial |
$26,180.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,520.00
|
| Rate for Payer: Cash Price |
$17,000.00
|
| Rate for Payer: Cigna Commercial |
$28,220.00
|
| Rate for Payer: First Health Commercial |
$32,300.00
|
| Rate for Payer: Humana Commercial |
$28,900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,880.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,092.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,540.00
|
| Rate for Payer: PHCS Commercial |
$32,640.00
|
| Rate for Payer: United Healthcare All Payer |
$29,920.00
|
|
|
MESH SURGIMND MP 20CM*20CM*2MM
|
Facility
|
OP
|
$34,000.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,420.00 |
| Max. Negotiated Rate |
$32,640.00 |
| Rate for Payer: Aetna Commercial |
$26,180.00
|
| Rate for Payer: Anthem Medicaid |
$11,692.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,520.00
|
| Rate for Payer: Cash Price |
$17,000.00
|
| Rate for Payer: Cigna Commercial |
$28,220.00
|
| Rate for Payer: First Health Commercial |
$32,300.00
|
| Rate for Payer: Humana Commercial |
$28,900.00
|
| Rate for Payer: Humana KY Medicaid |
$11,692.60
|
| Rate for Payer: Kentucky WC Medicaid |
$11,811.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,880.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,092.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,927.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,540.00
|
| Rate for Payer: PHCS Commercial |
$32,640.00
|
| Rate for Payer: United Healthcare All Payer |
$29,920.00
|
|
|
MESH SURGIMND MP 20CM*20CM*3MM
|
Facility
|
OP
|
$35,460.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,609.80 |
| Max. Negotiated Rate |
$34,041.60 |
| Rate for Payer: Aetna Commercial |
$27,304.20
|
| Rate for Payer: Anthem Medicaid |
$12,194.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,658.80
|
| Rate for Payer: Cash Price |
$17,730.00
|
| Rate for Payer: Cigna Commercial |
$29,431.80
|
| Rate for Payer: First Health Commercial |
$33,687.00
|
| Rate for Payer: Humana Commercial |
$30,141.00
|
| Rate for Payer: Humana KY Medicaid |
$12,194.69
|
| Rate for Payer: Kentucky WC Medicaid |
$12,318.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,077.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,169.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,638.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,439.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,204.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,609.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,992.60
|
| Rate for Payer: PHCS Commercial |
$34,041.60
|
| Rate for Payer: United Healthcare All Payer |
$31,204.80
|
|
|
MESH SURGIMND MP 20CM*20CM*3MM
|
Facility
|
IP
|
$35,460.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,609.80 |
| Max. Negotiated Rate |
$34,041.60 |
| Rate for Payer: Aetna Commercial |
$27,304.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,658.80
|
| Rate for Payer: Cash Price |
$17,730.00
|
| Rate for Payer: Cigna Commercial |
$29,431.80
|
| Rate for Payer: First Health Commercial |
$33,687.00
|
| Rate for Payer: Humana Commercial |
$30,141.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,077.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,169.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,638.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,204.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,609.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,992.60
|
| Rate for Payer: PHCS Commercial |
$34,041.60
|
| Rate for Payer: United Healthcare All Payer |
$31,204.80
|
|
|
MESH SURGIMND MP 20CM*25CM*2M
|
Facility
|
OP
|
$32,540.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
27000075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,230.20 |
| Max. Negotiated Rate |
$31,238.40 |
| Rate for Payer: Aetna Commercial |
$25,055.80
|
| Rate for Payer: Anthem Medicaid |
$11,190.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,381.20
|
| Rate for Payer: Cash Price |
$16,270.00
|
| Rate for Payer: Cigna Commercial |
$27,008.20
|
| Rate for Payer: First Health Commercial |
$30,913.00
|
| Rate for Payer: Humana Commercial |
$27,659.00
|
| Rate for Payer: Humana KY Medicaid |
$11,190.51
|
| Rate for Payer: Kentucky WC Medicaid |
$11,304.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,682.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,014.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,762.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,415.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,635.20
|
| Rate for Payer: Ohio Health Group HMO |
$24,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,508.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,230.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,087.40
|
| Rate for Payer: PHCS Commercial |
$31,238.40
|
| Rate for Payer: United Healthcare All Payer |
$28,635.20
|
|
|
MESH SURGIMND MP 20CM*25CM*2M
|
Facility
|
IP
|
$32,540.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
27000075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,230.20 |
| Max. Negotiated Rate |
$31,238.40 |
| Rate for Payer: Aetna Commercial |
$25,055.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,381.20
|
| Rate for Payer: Cash Price |
$16,270.00
|
| Rate for Payer: Cigna Commercial |
$27,008.20
|
| Rate for Payer: First Health Commercial |
$30,913.00
|
| Rate for Payer: Humana Commercial |
$27,659.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,682.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,014.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,762.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,635.20
|
| Rate for Payer: Ohio Health Group HMO |
$24,405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,508.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,230.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,087.40
|
| Rate for Payer: PHCS Commercial |
$31,238.40
|
| Rate for Payer: United Healthcare All Payer |
$28,635.20
|
|
|
MESH SURGIMND MP 20CM*30CM*2MM
|
Facility
|
OP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem Medicaid |
$25,001.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Humana KY Medicaid |
$25,001.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,255.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,503.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
|
MESH SURGIMND MP 20CM*30CM*2MM
|
Facility
|
IP
|
$72,700.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,451.00 |
| Max. Negotiated Rate |
$69,792.00 |
| Rate for Payer: Aetna Commercial |
$55,979.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,706.00
|
| Rate for Payer: Cash Price |
$36,350.00
|
| Rate for Payer: Cigna Commercial |
$60,341.00
|
| Rate for Payer: First Health Commercial |
$69,065.00
|
| Rate for Payer: Humana Commercial |
$61,795.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,652.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$54,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,537.00
|
| Rate for Payer: PHCS Commercial |
$69,792.00
|
| Rate for Payer: United Healthcare All Payer |
$63,976.00
|
|
